Provider Demographics
NPI:1245011261
Name:TARA VINES , LLC
Entity type:Organization
Organization Name:TARA VINES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-422-9547
Mailing Address - Street 1:404 BOWER CT
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3206
Mailing Address - Country:US
Mailing Address - Phone:205-422-9547
Mailing Address - Fax:
Practice Address - Street 1:2324 VALLEYDALE RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2078
Practice Address - Country:US
Practice Address - Phone:205-422-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty